The health and welfare of your child while at school is top priority. Please carefully complete this form as accurately as possible. Please keep the school informed of any changes that may occur during the course of the school year. This information is VITAL if your child becomes ill or injured while at school.

By completing this questionnaire, you help the district comply with the McKinney-Vento Act, Title X, Part C of the No Child Left Behind Act. Your truthful and accurate answers help the district identify services that your student may be eligible to receive.